by Dr Sophie Genoni of Femma
Returning to work after having a child or children is a unique transition with many factors to consider in a woman’s physical and emotional health. Consulting Femma GP Dr Sophie Genoni takes us through a handful of considerations that might just make this transition easier!
Problems in pregnancy
Women may experience complications in their pregnancy that require follow-up or further treatment after their baby is born. These conditions are usually addressed at a woman’s 6 week check with their health professional, but may also require further monitoring and treatment at a later stage. Some of these conditions can cause ongoing symptoms that may affect a woman’s ability to maintain concentration, energy levels, and performance at work.
Iron deficiency is common in pregnancy, and some women may have been advised to take iron supplements or have an iron infusion. Post-partum haemorrhage during birth can deplete iron stores further. Iron levels should be monitored after birth in women who experience iron deficiency in pregnancy or a post-partum haemorrhage, and may require further supplementation. Symptoms of iron deficiency include tiredness, fatigue, breathlessness, lightheadedness and hair/nail changes.
Gestational diabetes is a form of diabetes that only occurs during pregnancy. However, women who experience gestational diabetes are at a higher risk of developing type 2 diabetes. After a pregnancy complicated by gestational diabetes, women should have their blood sugar levels checked after pregnancy, and every 1-2 years thereafter. Symptoms of type 2 diabetes include tiredness, fatigue, excessive thirst, excessive urination and headaches.
High blood pressure can occur in pregnancy and can sometimes be associated with a condition called pre-eclampsia. Women who experience either of these conditions are at a higher risk of developing high blood pressure and cardiovascular disease after pregnancy. It is important that women at risk of these conditions consult their health professional regarding the individual monitoring required for their situation, particularly for women who work in physically active or high stress environments.
Sleep
Depending on the stage at which a woman chooses to return to work, her baby or child may still be experiencing night waking due to their normal biological needs. Parental disrupted sleep can lead to tiredness, fatigue, decreased exercise tolerance and decreased stress tolerance. Women returning to the workforce should be encouraged to optimise their sleep efficiency by being aware of healthy sleep habits. This will help to minimise the impact of any night waking.
Some examples of healthy sleep habits include:
- Going to bed and waking at the same time each day to assist the circadian rhythm
- Having a relaxing routine in the hours before bedtime, including no screen-time
- Minimising caffeine after lunch time
- Ensuring not to lie in bed if you cannot fall asleep or if you wake during the night – get out of bed and do a relaxing activity for 15-20 minutes before trying to fall asleep again
- If your mind is kept awake by busy thoughts, mindfulness exercises can be helpful
Mood
Pregnancy, birth and raising young children is a time of vast emotional changes. Becoming a parent is often the biggest change a woman experiences in her lifetime. Returning to work after early parenthood is yet again another big change. Whilst there can be many positive aspects to returning to work, many women experience some difficult thoughts and feelings around this transition, including guilt, stress, exhaustion and overwhelm.
During the transition back to work, women may find it helpful to:
- Acknowledge these difficult thoughts and feelings
- Remind themselves that their version of working and parenting is what works for their individual family unit, and may be different to other families
- Trust that their family unit will navigate through these changes, and that it is ok if this takes time
- Ensure they have a support network of friends, family and trusted health professionals
A small number of women may experience more distressing emotions that impact their daily function, which requires the support of their GP or mental health professional.
Pelvic floor
It is well known that pelvic floor muscles are impacted by pregnancy and birth. Women may experience symptoms of pelvic floor dysfunction after having children, including urinary frequency and urgency, bladder and bowel incontinence and pelvic heaviness. Women may find these symptoms may become more noticeable on return to the workplace if access to a toilet is more limited than in their own household, and this may cause some distress. Assessment and management by a women’s health physiotherapist or GP can ensure the correct diagnosis is made and guide management. Pelvic floor exercises are the first-line treatment for mild pelvic floor dysfunction.
Musculoskeletal
It is common to develop lower back, neck and wrist pain whilst caring for children. These issues can develop from repetitive movements and poor posture during activities such as carrying children and breastfeeding. On returning to work, these issues may be further compounded by computer or desk work, heavy lifting, prolonged standing or repetitive tasks. It can be helpful to address any musculoskeletal pains with a physiotherapist prior to returning to work. Strength and core exercises such as Pilates can be particularly helpful for back pain.
Exercise
Exercise is beneficial for sleep, mood and relieving some musculoskeletal issues. It also has long-term benefits for cardiovascular health. Balancing work and caring for children can make it harder for women to find time to exercise. Exercise or movement can come in any form, and can last for any duration that works with a woman’s other commitments. It can be helpful to schedule a form of movement into the daily routine, without undue pressure if there are days where it is not possible.
Breastfeeding
Women may be returning to work while still breastfeeding their baby or child, and should be encouraged to continue breastfeeding if they choose to. There are important considerations to help the transition go as smoothly as possible. Some women may be able to continue direct breastfeeding their child if their workplace is close enough to where their child is being cared for. However, most women who continue breastfeeding after returning to work will use expressed breast milk.
Women can discuss their breastfeeding plans and goals with their employer, to ensure their employer is aware of the breaks required, and to organise a comfortable and private area for expressing. There are legal rights for women and requirements of employers, which are detailed in the Fair Work Act and Anti-Discrimination Act.
Women who are providing expressed breast milk for their child will need to ensure that they express milk at regular intervals. This is important to avoid engorgement, mastitis and low milk supply. When milk is not regularly emptied from the breasts it can cause milk stasis and inflammation, leading to blocked ducts and mastitis. Mastitis is characterised by a firm, red, tender area of the breast, and often accompanied by fever and feeling unwell. It can progress quite quickly and lead to a breast abscess when not treated. Treatment includes relieving the milk stasis by emptying the breasts, and often antibiotics are required to treat the infection. Inadequate breast emptying will also signal for the breasts to downregulate milk production. Over time this can lead to low milk supply, so it is important to ensure regular expressing breaks. The frequency and timing of these will be different for each individual woman and child, so it can be helpful to discuss this with a health professional such as a GP, lactation consultant or maternal and child health nurse.
References
Australian Breastfeeding Association. 2021. Mastitis (Accessed: https://www.breastfeeding.asn.au/bf-info/common-concerns%E2%80%93mum/mastitis)
Australian Breastfeeding Association. 2016. Working mothers (Accessed: https://www.breastfeeding.asn.au/workplace/working-mothers)
Balendran, Shalini & Forsyth, Cecily. 2021. Non-anaemia iron deficiency. Australian Prescriber 2021; 44:193-6 (Accessed: https://www.nps.org.au/australian-prescriber/articles/non-anaemic-iron-deficiency)
Continence Foundation of Australia. 2022. Pelvic Floor First: Signs of a pelvic floor problem (Accessed: https://www.pelvicfloorfirst.org.au/pages/how-can-i-tellif-i-have-a-pelvic-floor-problem.html)
Continence Foundation of Australia. 2020. Continence health: Pelvic floor muscles. (Accessed: https://www.continence.org.au/about-continence/continence-health/pelvic-floor)
Diabetes Australia. 2022. Gestational Diabetes (Accessed: https://www.diabetesaustralia.com.au/about-diabetes/gestational-diabetes/)
Heart Foundation. 2022. Pregnancy and heart disease: Information and resources for health professionals (Accessed: https://www.heartfoundation.org.au/conditions/fp-pregnancy-and-heart-disease)
Inge, Phillipa et al. 2022. Exercise after pregnancy. Australian Journal of General Practice 2022; 51: 117-21 (Accessed: https://www1.racgp.org.au/ajgp/2022/march/exercise-after-pregnancy)
PANDA. 2022. Support for new parents (Accessed: https://panda.org.au/get-support/support-new-parents)
Possums & Co. 2020. Mental Health Tips for Parents With Babies (ACT) (Accessed: https://possumsonline.com/act-mental-health-strategies-parents-babies)
Raising Children. 2022. Breastfeeding: mums returning to work (Accessed: https://raisingchildren.net.au/newborns/breastfeeding-bottle-feeding/expressing-working-travelling/breastfeeding-returning-to-work)
Sleep Health Foundation. 2022. Sleep Hygiene: Good Sleep Habits (Accessed: https://www.sleephealthfoundation.org.au/good-sleep-habits.html)
